TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) MARY BROWN........................................................................ BOARD MEMBER PT YR	1.00 .......................0.00	X				0	0	0
(2) DR NHAN NGUYEN........................................................................ BOARD MEMBER PT YR	40.00 .......................0.00	X				96,072	0	0
(3) ANN MARY BRANGAN........................................................................ BOARD MEMBER PT YR	1.00 .......................0.00	X				0	0	0
(4) JEAN JENSEN........................................................................ BOARD MEMBER PT YR	1.00 .......................0.00	X				0	0	0
(5) SR BETTE BLUHM........................................................................ BOARD MEMBER PT YR	1.00 .......................0.00	X				0	0	0
(6) JAN HAMILTON-CRAWFORD........................................................................ PRESIDENT (EFF. DATE 5/4/15)	1.00 .......................40.00	X	X			0	295,342	26,769
(7) RANDY SAFADY........................................................................ BOARD MEMBER	1.00 .......................39.00	X				0	1,745,728	375,261
(8) PAUL GENERALE........................................................................ BOARD MEMBER	1.00 .......................39.00	X				0	1,118,721	310,314
(9) MIKE MURRAY........................................................................ CFO	2.00 .......................38.00		X			0	272,362	75,672
(10) MATTHEW E SMITH........................................................................ CORPORATE SECRETARY PT YR	0.00 .......................40.00		X			141,397	0	1,650
(11) TONI MILLS........................................................................ CHIEF EXEC. OFFICER(THROUGH 5/4/15)	40.00 .......................0.00		X			96,282	0	0
(12) HOLLY POWELL........................................................................ ADMINISTRATOR	40.00 .......................0.00			X		160,747	0	22,763
(13) FIONA ADAMS........................................................................ REG. CLIN. ADMINISTRATOR	40.00 .......................0.00			X		230,097	0	24,185
(14) DIANE KAISER........................................................................ ADMINISTRATOR	40.00 .......................0.00			X		207,422	0	22,741
(15) SAM BARKMAN........................................................................ VP OF STRATEGIC INITIATIVES	40.00 .......................0.00			X		226,158	0	3,393
(16) DAVID F COOK........................................................................ SYSTEM DIR. OF INFORMATION TECHNOLOGY SOLUTIONS	40.00 .......................0.00			X		120,510	0	1,652
(17) STEPHEN A MILLS........................................................................ FORMER OFFICER	40.00 .......................0.00				X	317,969	0	1,138

(A) Name and business address	(B) Description of services	(C) Compensation
CHRISTUS SPOHN MEDICAL CENTER 600 ELIZABETH STREET CORPUS CHRISTI,TX784040000	ANCILLARY SERVICES	1,621,827
CHRISTUS ST MICHAEL HEALTH CARE CENTER PO BOX 2911 TEXARKANA,TX75504	ANCILLARY SERVICES	1,021,844
WADLEY REGIONAL MEDICAL CENTER 922 OLIVE STREET TEXARKANA,TX755010000	ANCILLARY SERVICES	658,588
CHRISTUS HEALTH NORTHERN LOUISIANA ONE ST MARY PLACE SHREVEPORT,LA71101	ANCILLARY SERVICES	363,410
MERCY HOSPITAL FORT SMITH PO BOX 504273 ST LOUIS,MO631504273	ANCILLARY SERVICES	330,521
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 13

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,266	2,266
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	306,658		306,658
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	3,626,384	3,534,964	91,420
7	Other salaries and wages ....
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	50,018	44,561	5,457
9	Other employee benefits .......	497,101	442,867	54,234
10	Payroll taxes ...........	349,350	311,236	38,114
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	34,249		34,249
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	899,134	82,338	816,796
12	Advertising and promotion ....	294		294
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	707,974	624,269	83,705
17	Travel ............	85,423	4,954	80,469
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	23,082		23,082
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	92,638	92,638
23	Insurance ..............	41,038	30,778	10,260
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PURCHASED SERVICES	1,952,601	1,857,174	95,427	0
b	SUPPLIES	1,730,910	1,724,397	6,513	0
c	EQUIPMENT RENTAL	210,756	192,084	18,672	0
d
e	All other expenses	1,086,731	202,363	884,368
25	Total functional expenses. Add lines 1 through 24e	11,696,607	9,146,889	2,549,718	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	16,278,625	2	20,353,524
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	5,196,374	4
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............	1,763,000	7	456,929
8	Inventories for sale or use ..............	437,473	8
9	Prepaid expenses and deferred charges ..........	82,603	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	0
b	Less: accumulated depreciation .....	10b	0	0	10c	0
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	1,682,368	15	459,361
16	Total assets. Add lines 1 through 15 (must equal line 34)......	25,440,443	16	21,269,814
	17	Accounts payable and accrued expenses .........	4,513,681	17	1,179,134
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	6,142,483	25	2,688,801
26	Total liabilities. Add lines 17 through 25.........	10,656,164	26	3,867,935
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	14,784,279	27	17,401,879
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	14,784,279	33	17,401,879
34	Total liabilities and net assets/fund balances ........	25,440,443	34	21,269,814

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

884

Total. Add lines 1c through 1i ...............................

884

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	A PERCENTAGE OF DUES PAID TO ORGANIZATIONS WERE USED FOR LOBBYING. THESE INCLUDE DUES PAID TO AMERICAN NURSES ASSOCIATION, TEXAS NURSES ASSOCIATION, CATHOLIC HEALTH ASSOCIATION OF TEXAS, AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES AND NATIONAL ASSOCIATION OF LONG-TERM CARE HOSPITALS.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(d) Book value
1a	Land .................
b	Buildings ................
c	Leasehold improvements ............
d	Equipment ................
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......		0

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
THIRD PARTY PAYOR SETTLEMENTS		2,688,801








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		2,688,801
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	14,534		14,534	0.120 %
b	Medicaid (from Worksheet 3, column a) ....				0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	17,684	12,423	5,261	0.050 %
d	Total Financial Assistance and Means-Tested Government Programs .	32,218	12,423	19,795	0.170 %
Other Benefits					0 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..				0 %
f	Health professions education (from Worksheet 5) ..	768		768	0.010 %
g	Subsidized health services (from Worksheet 6) ..				0 %
h	Research (from Worksheet 7)				0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)				0 %
j	Total. Other Benefits ..	768		768	0.010 %
k	Total. Add lines 7d and 7j .	32,986	12,423	20,563	0.180 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(f) Percent of total expense
1	Physical improvements and housing	0 %
2	Economic development	0 %
3	Community support	0 %
4	Environmental improvements	0 %
5	Leadership development and training for community members	0 %
6	Coalition building	0 %
7	Community health improvement advocacy	0 %
8	Workforce development	0 %
9	Other	0 %
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

116,021

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

20,491,513

Enter Medicare allowable costs of care relating to payments on line 5.....

22,273,601

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-1,782,088

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?5 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)			Other (describe)	Facility reporting group
1	DUBUIS HOSPITAL OF TEXARKANA - NORTH 2400 ST MICHAEL DRIVE 2ND FLOOR TEXARKANA,TX75503 WWW.CHRISTUSDUBUIS.ORG 008476	X	LONG-TERM ACUTE CARE HOSPITAL	A
2	DUBUIS HOSPITAL OF CORPUS CHRISTI 600 ELIZABETH STREET 3RD FLOOR CORPUS CHRISTI,TX78404 WWW.CHRISTUSDUBUIS.ORG 007970	X	LONG-TERM ACUTE CARE HOSPITAL	A
3	DUBUIS HOSPITAL OF TEXARKANA - SOUTH 1000 PINE STREET 6TH FLOOR TEXARKANA,TX75501 WWW.CHRISTUSDUBUIS.ORG 008476	X	LONG-TERM ACUTE CARE HOSPITAL	A
4	ADVANCE CARE HOSPITAL OF HOT SPRINGS 300 WERNER STREET 3RD FLOOR HOT SPRINGS,AR71913 WWW.CHRISTUSDUBUIS.ORG AR5070	X	LONG-TERM ACUTE CARE HOSPITAL	A
5	ADVANCE CARE HOSPITAL OF FORT SMITH 7301 ROGERS AVENUE 4TH FLOOR FORT SMITH,AR72917 WWW.CHRISTUSDUBUIS.ORG AR5071	X	LONG-TERM ACUTE CARE HOSPITAL	A

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 1: DUBUIS HOSPITAL OF TEXARKANA - NORTH, - FACILITY 2: DUBUIS HOSPITAL OF CORPUS CHRISTI, - FACILITY 3: DUBUIS HOSPITAL OF TEXARKANA - SOUTH, - FACILITY 4: ADVANCE CARE HOSPITAL OF HOT SPRINGS, - FACILITY 5: ADVANCE CARE HOSPITAL OF FORT SMITH
GROUP A-FACILITY 1 -- DUBUIS HOSPITAL OF TEXARKANA - NORTH PART V, SECTION B, LINE 5:	THE HOSPITAL'S REPRESENTATIVES ASKED LOCAL EXPERT AREA RESIDENTS TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY. ADDITIONALLY, THEY UTILIZED DATA FROM PUBLIC INTERNET SOURCES AND SURVEYED AND INTERVIEWED LOCAL EXPERT ADVISORS TO GAIN LOCAL INPUT TO DEVELOP AN INTENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT.
GROUP A-FACILITY 1 -- DUBUIS HOSPITAL OF TEXARKANA - NORTH PART V, SECTION B, LINE 6A:	BECAUSE DUBUIS HOSPITAL OF TEXARKANA IS LOCATED WITHIN CHRISTUS ST. MICHAEL HOSPITAL, SERVES THE SAME POPULATION, AND IS OWNED BY THE SAME PARENT COMPANY, THE HOSPITAL USES THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY CHRISTUS ST. MICHAEL HEALTH SYSTEM TO DETERMINE THE HEALTH NEEDS AND FUTURE COMMUNITY BENEFIT PLANS.
GROUP A-FACILITY 1 -- DUBUIS HOSPITAL OF TEXARKANA - NORTH PART V, SECTION B, LINE 11:	BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED ON BEHALF OF THE HOST HOSPITAL, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AS PRIMARY AREAS OF FOCUS FOR THE SERVICE AREA. PRIMARY COMMUNITY NEEDS IDENTIFIED:-MENTAL HEALTH/SUICIDE-OBESITY/OVERWEIGHT-COMPLIANCE BEHAVIOR-EDUCATION-DIABETES-AFFORDABILITY-CORONARY HEART DISEASE OTHER HEALTH NEEDS IDENTIFIED:-ALCOHOL ABUSE-MATERNAL AND INFANT MEASURES-PHYSICIANS-CANCER-PRIORITY POPULATIONS-HEALTHY FOOD-DENTAL-CHOLESTEROL-LUNG DISEASE-SMOKING/TOBACCO USE-ACCIDENTS-BLOOD PRESSURE-STROKE-SEXUALLY TRANSMITTED DISEASE-HOMICIDE/VIOLENT CRIME-PALLIATIVE CARE-KIDNEY DISEASE-LONG TERM MENTAL HEALTH SUPPORT/COUNSELING-LOW BACK PAIN-PHYSICAL ENVIRONMENT-FLU/PNEUMONIA-LIFE EXPECTANCY/PREMATURE DEATHDUBUIS HOSPITAL OF TEXARKANA WILL FOCUS EFFORTS TO PROVIDE LONG TERM ACUTE CARE SERVICES TO INDIVIDUALS WHO HAVE LIMITED RESOURCES WITH LITTLE OR NO INSURANCE. THE PRIORITIES ARE LIMITED DUE TO LACK OF ADEQUATE RESOURCES AND REGULATORY LIMITATIONS ON THE TYPES OF PATIENTS THAT CAN BE SERVED IN LONG TERM ACUTE CARE FACILITIES. CHARITY CARE WILL BE THE FOCUS OF SERVICES PROVIDED BY DUBUIS HEALTH SYSTEM, INC.
GROUP A-FACILITY 1 -- DUBUIS HOSPITAL OF TEXARKANA - NORTH PART V, SECTION B, LINE 13H:	TO DETERMINE CHARGES TO PATIENTS, THE FACILITY UTILIZES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES AND OTHER CRITERIA APPLIED TO A UNIFORM FEE SCHEDULE. THE FACILITY HAS IMPLEMENTED A 3 TIER UNINSURED FEE SCHEDULE WHEREIN INDIVIDUALS BETWEEN 201-300% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; INDIVIDUALS BETWEEN 301%-400% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; AND INDIVIDUALS ABOVE 401% OF THE FEDERAL POVERTY LEVEL RECEIVE NO ADDITIONAL DISCOUNT OFF OF THE UNINSURED DISCOUNTED PRICE. THERE IS NO FEDERAL POVERTY LIMIT FOR THE UNINSURED POPULATION TO RECEIVE DISCOUNTED CARE BECAUSE ALL CHARGES BY THE FACILITY ARE BASED ON THE UNINSURED DISCOUNTED PRICE. THE UNINSURED DISCOUNTED PRICE IS BASED ON THE FY 2014 MANAGED CARE AVERAGE REIMBURSEMENT RATE. BASIS FOR DETERMINING CHARGES TO PATIENTSTHE CRITERIA FACTORS FOR CALCULATING CHARGES TO PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE INCLUDES FAMILY SIZE, EMPLOYMENT STATUS AND FUTURE EARNING CAPACITY AND THE AMOUNT AND FREQUENCY OF HOSPITAL/MEDICAL BILLS.
GROUP A-FACILITY 1 -- DUBUIS HOSPITAL OF TEXARKANA - NORTH PART V, SECTION B, LINE 16I:	HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICYTHE ORGANIZATION'S ONLY OPERATIONS ARE LONG TERM ACUTE CARE SERVICES (LTAC) THAT COMPRISE A FLOOR WITHIN AN EXISTING HOSPITAL(S). AS LTAC FACILITY DOES NOT PROVIDE ON-DEMAND EMERGENCY MEDICAL SERVICES/ELECTIVE TREATMENTS, THE ADMISSIONS PROCESS IS AN ADVANCE SCREENING AND CLINICAL ASSESSMENT DURING WHICH BOTH MEDICAL AND FINANCIAL INFORMATION IS DISCUSSED. IF THERE IS NO INSURANCE COVERAGE FINANCIAL ASSISTANCE IS DISCUSSED AND DETERMINED.
GROUP A-FACILITY 1 -- DUBUIS HOSPITAL OF TEXARKANA - NORTH PART V, SECTION B, LINE 22D:	TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, LTAC FACILITIES DO NOT PROVIDE EMERGENCY MEDICAL CARE; CHARGES TO FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENTS ARE BASED ON THE AVERAGE MANAGED CARE REIMBURSEMENT RATES FOR THE FISCAL YEAR ENDING JUNE 30, 2014. THE AVERAGE MANAGED CARE RATE IS THE AVERAGE REIMBURSEMENT RECEIVED FOR LTAC SERVICES FROM THE COLLECTIVE GROUP OF PRIVATE INSURERS CONTRACTED WITH CHRISTUS CONTINUING CARE.
GROUP A-FACILITY 2 -- DUBUIS HOSPITAL OF CORPUS CHRISTI PART V, SECTION B, LINE 5:	IN ADDITION TO NUMEROUS CHRISTUS HEALTH ASSOCIATES, THE COMMITTEE ALSO CONSISTED OF A REPRESENTATIVE FROM THE CORPUS CHRISTI INDEPENDENT SCHOOL DISTRICT, CORPUS CHRISTI/NUECES COUNTY HEALTH DEPARTMENT, DEL MAR COLLEGE, FQHC RURAL COMMUNITY ACTION CORPORATION OF SOUTH TEXAS NUECES COUNTY MEDICAL SOCIETY, AND THE SAN PATRICIO COUNTY HEALTH DEPARTMENT. THE SOCIAL SCIENCE AND RESEARCH CENTER, COLLEGE OF LIBERAL ARTS, AT TEXAS A&M UNIVERSITY WAS CONTRACTED BY THE COASTAL BEND HEALTH NEEDS ASSESSMENT STEERING COMMITTEE TO CONDUCT THE NEEDS ASSESSMENT.
GROUP A-FACILITY 2 -- DUBUIS HOSPITAL OF CORPUS CHRISTI PART V, SECTION B, LINE 6A:	BECAUSE DUBUIS HOSPITAL OF CORPUS CHRISTI IS LOCATED WITHIN CHRISTUS SPOHN SHORELINE, SERVES THE SAME POPULATION, AND IS OWNED BY THE SAME PARENT COMPANY, THE HOSPITAL PARTICIPATED IN AND USES THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY CHRISTUS SPOHN HEALTH SYSTEM TO DETERMINE THE HEALTH NEEDS AND FUTURE COMMUNITY BENEFIT PLANS.
GROUP A-FACILITY 2 -- DUBUIS HOSPITAL OF CORPUS CHRISTI PART V, SECTION B, LINE 11:	BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED ON BEHALF OF THE HOST HOSPITAL, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AS PRIMARY AREAS OF FOCUS FOR THE SERVICE AREA.HEALTH CONCERNS: INTEGRATE HEALTH CARE THROUGH THE CONTINUUM OF CARE AND PATIENT NAVIGATORS PATIENT NAVIGATORS PROVIDE CULTURALLY SENSITIVE ASSISTANCE AND CARE-COORDINATION, GUIDING PATIENTS THROUGH AVAILABLE MEDICAL, INSURANCE, AND SOCIAL SUPPORT SYSTEMS. THE GOAL OF THE PATIENT NAVIGATION SYSTEM IS TO REDUCE DISPARITIES IN HEALTH CARE ACCESS AND INCREASE HEALTHY OUTCOMES. INCREASE HEALTH LITERACY HEALTH LITERACY IS THE DEGREE TO WHICH PEOPLE OBTAIN, PROCESS, AND UNDERSTAND BASIC HEALTH INFORMATION AND SERVICES IN ORDER TO MAKE APPROPRIATE DECISIONS ABOUT THEIR HEALTH. STUDIES INDICATE THAT BETWEEN 25-50% OF THE U.S. POPULATION HAS LIMITED HEALTH LITERACY. THE ELDERLY AND LOW INCOME ARE THE MOST LIKELY TO HAVE LOWER LEVELS OF HEALTH LITERACY (EICHLER ET AL, 2009). LOW LEVELS OF HEALTH LITERACY ARE ASSOCIATED WITH POOR USE OF HEALTH SERVICES AND HEALTH OUTCOMES. INCREASE PRIMARY CARE ACCESS THERE ARE MANY BARRIERS TO HEALTH CARE IN THE COASTAL BEND. MANY IN OUR AREA DO NOT HAVE HEALTH INSURANCE THAT LIMITS THEIR ACCESS TO ROUTINE HEALTH CARE. OVER 34% OF THE TELEPHONE SURVEY RESPONDENTS AND 25.1% OF THE PERSON-TO-PERSON INTERVIEWEES REPORTED NOT HAVING ANY KIND OF HEALTH INSURANCE. THE COUNTY RANKINGS INDICATED THAT 24.5% OF COASTAL BEND COUNTY RESIDENTS ARE UNINSURED. DECREASE PREVENTABLE HOSPITALIZATIONS PNEUMONIA AND UTIS ARE SOME OF THE MOST COMMON DIAGNOSES IN THE HOSPITAL AND EMERGENCY DEPARTMENT DATA. THE COUNTY RANKINGS REVEALED THAT THE COASTAL BEND COUNTIES ARE HIGHER IN PREVENTABLE HOSPITALIZATIONS THAN TEXAS OR THE U.S. NATIONAL BENCHMARKS. THESE INFECTIOUS DISEASES CAN BE AVOIDED THROUGH PNEUMONIA VACCINATION PROGRAMS AND EDUCATION ON HOW TO PREVENT UTIS AND PNEUMONIA. MORE ANALYSES ABOUT THE PATIENTS WHO SUFFER FROM THESE AILMENTS ARE PRUDENT ENDEAVORS. IF PATIENTS WITH UTIS ARE COMING FROM NURSING HOMES OR HAVE CATHETERS, THEN EFFORTS TO DECREASE UTIS MAY FOCUS ON EDUCATING CAREGIVERS ABOUT THE MAINTENANCE AND MANAGEMENT OF CATHETERS. IT WOULD BE PRUDENT TO LEARN IF THOSE WHO ENTERED THE HEALTH CARE SYSTEM WITH PNEUMONIA RECEIVED PNEUMONIA VACCINATION. IF THEY DID NOT, IT WOULD BE IMPORTANT TO ADDRESS THE BARRIERS TO PNEUMONIA VACCINATIONS. KNOWING MORE ABOUT HOW THE PATIENTS CAME TO THE HOSPITAL IS THE FIRST STEP THE REDUCING PREVENTABLE HOSPITALIZATIONS. THE NEXT STEP IS TO HAVE MORE EFFECTIVE DISCHARGE PLANNING AND FOLLOW-UP. IMPROVE CHILDREN'S HEALTH STATUS THE CHILDREN'S DATA SHOWED THAT ASTHMA DIAGNOSIS, ACTIVE ASTHMA, OBESITY AND PREMATURE BIRTHS WERE HIGHER THAN TEXAS AND THE NATION. CHILDREN WHO HAD PARENTS OVER THE AGE OF 44 AND LIVED IN RURAL AREAS WERE MORE LIKELY TO SUFFER FROM THESE CONDITIONS. CHILDREN WHOSE PARENTS WERE UNINSURED AND HISPANIC WERE MORE LIKELY TO HAVE THESE CONDITIONS. IN OTHER WORDS, CHILDREN WHO LIVED IN RURAL AREAS AND WERE POORER WERE MORE VULNERABLE TO POOR HEALTH STATUS. IMPROVE WOMEN'S HEALTH STATUS TO IMPROVE CHILDREN'S HEALTH STARTS WITH IMPROVING THE HEALTH STATUS AND ACCESS FOR WOMEN. THE DATA INDICATE THAT MANY WOMEN IN THE COASTAL BEND ARE NOT RECEIVING PAP SMEARS AND MAMMOGRAMS. THIS LACK OF SCREENING LEADS TO MORE SERIOUS CONDITIONS SUCH AS LATE STAGE CANCER, IF THERE ARE NO EARLY INTERVENTIONS. HEALTH SCREENINGS ARE ESSENTIAL TO PREVENTING CHRONIC DISEASE AND POSSIBLY EARLY DEATHS.DUBUIS HOSPITAL OF CORPUS CHRISTI WILL FOCUS EFFORTS TO PROVIDE LONG TERM ACUTE CARE SERVICES TO INDIVIDUALS WHO HAVE LIMITED RESOURCES WITH LITTLE OR NO INSURANCE. THE PRIORITIES ARE LIMITED DUE TO LACK OF ADEQUATE RESOURCES AND REGULATORY LIMITATIONS ON THE TYPES OF PATIENTS THAT CAN BE SERVED IN LONG TERM ACUTE CARE FACILITIES. CHARITY CARE WILL BE THE FOCUS OF SERVICES PROVIDED BY DUBUIS HEALTH SYSTEM, INC.
GROUP A-FACILITY 2 -- DUBUIS HOSPITAL OF CORPUS CHRISTI PART V, SECTION B, LINE 13H:	TO DETERMINE CHARGES TO PATIENTS, THE FACILITY UTILIZES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES AND OTHER CRITERIA APPLIED TO A UNIFORM FEE SCHEDULE. THE FACILITY HAS IMPLEMENTED A 3 TIER UNINSURED FEE SCHEDULE WHEREIN INDIVIDUALS BETWEEN 201-300% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; INDIVIDUALS BETWEEN 301%-400% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; AND INDIVIDUALS ABOVE 401% OF THE FEDERAL POVERTY LEVEL RECEIVE NO ADDITIONAL DISCOUNT OFF OF THE UNINSURED DISCOUNTED PRICE. THERE IS NO FEDERAL POVERTY LIMIT FOR THE UNINSURED POPULATION TO RECEIVE DISCOUNTED CARE BECAUSE ALL CHARGES BY THE FACILITY ARE BASED ON THE UNINSURED DISCOUNTED PRICE. THE UNINSURED DISCOUNTED PRICE IS BASED ON THE FY 2014 MANAGED CARE AVERAGE REIMBURSEMENT RATE. BASIS FOR DETERMINING CHARGES TO PATIENTSTHE CRITERIA FACTORS FOR CALCULATING CHARGES TO PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE INCLUDES FAMILY SIZE, EMPLOYMENT STATUS AND FUTURE EARNING CAPACITY AND THE AMOUNT AND FREQUENCY OF HOSPITAL/MEDICAL BILLS.
GROUP A-FACILITY 2 -- DUBUIS HOSPITAL OF CORPUS CHRISTI PART V, SECTION B, LINE 16I:	HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICYTHE ORGANIZATION'S ONLY OPERATIONS ARE LONG TERM ACUTE CARE SERVICES (LTAC) THAT COMPRISE A FLOOR WITHIN AN EXISTING HOSPITAL(S). AS LTAC FACILITY DOES NOT PROVIDE ON-DEMAND EMERGENCY MEDICAL SERVICES/ELECTIVE TREATMENTS, THE ADMISSIONS PROCESS IS AN ADVANCE SCREENING AND CLINICAL ASSESSMENT DURING WHICH BOTH MEDICAL AND FINANCIAL INFORMATION IS DISCUSSED. IF THERE IS NO INSURANCE COVERAGE FINANCIAL ASSISTANCE IS DISCUSSED AND DETERMINED.
GROUP A-FACILITY 2 -- DUBUIS HOSPITAL OF CORPUS CHRISTI PART V, SECTION B, LINE 22D:	TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, LTAC FACILITIES DO NOT PROVIDE EMERGENCY MEDICAL CARE; CHARGES TO FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENTS ARE BASED ON THE AVERAGE MANAGED CARE REIMBURSEMENT RATES FOR THE FISCAL YEAR ENDING JUNE 30, 2013. THE AVERAGE MANAGED CARE RATE IS THE AVERAGE REIMBURSEMENT RECEIVED FOR LTAC SERVICES FROM THE COLLECTIVE GROUP OF PRIVATE INSURERS CONTRACTED WITH CHRISTUS CONTINUING CARE.
GROUP A-FACILITY 3 -- DUBUIS HOSPITAL OF TEXARKANA - SOUTH PART V, SECTION B, LINE 5:	THE HOSPITAL'S REPRESENTATIVES ASKED LOCAL EXPERT AREA RESIDENTS TO NOTE IF THEY PERCEIVED THE PROBLEMS OR NEEDS IDENTIFIED BY SECONDARY SOURCES TO EXIST IN THEIR PORTION OF THE COUNTY. ADDITIONALLY, THEY UTILIZED DATA FROM PUBLIC INTERNET SOURCES AND SURVEYED AND INTERVIEWED LOCAL EXPERT ADVISORS TO GAIN LOCAL INPUT TO DEVELOP AN INTENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT.
GROUP A-FACILITY 3 -- DUBUIS HOSPITAL OF TEXARKANA - SOUTH PART V, SECTION B, LINE 6A:	BECAUSE DUBUIS HOSPITAL OF TEXARKANA IS LOCATED WITHIN CHRISTUS ST. MICHAEL HOSPITAL, SERVES THE SAME POPULATION, AND IS OWNED BY THE SAME PARENT COMPANY, THE HOSPITAL USES THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY CHRISTUS ST. MICHAEL HEALTH SYSTEM TO DETERMINE THE HEALTH NEEDS AND FUTURE COMMUNITY BENEFIT PLANS.
GROUP A-FACILITY 3 -- DUBUIS HOSPITAL OF TEXARKANA - SOUTH PART V, SECTION B, LINE 11:	BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED ON BEHALF OF THE HOST HOSPITAL, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AS PRIMARY AREAS OF FOCUS FOR THE SERVICE AREA. PRIMARY COMMUNITY NEEDS IDENTIFIED:-MENTAL HEALTH/SUICIDE-OBESITY/OVERWEIGHT-COMPLIANCE BEHAVIOR-EDUCATION-DIABETES-AFFORDABILITY-CORONARY HEART DISEASE OTHER HEALTH NEEDS IDENTIFIED:-ALCOHOL ABUSE-MATERNAL AND INFANT MEASURES-PHYSICIANS-CANCER-PRIORITY POPULATIONS-HEALTHY FOOD-DENTAL-CHOLESTEROL-LUNG DISEASE-SMOKING/TOBACCO USE-ACCIDENTS-BLOOD PRESSURE-STROKE-SEXUALLY TRANSMITTED DISEASE-HOMICIDE/VIOLENT CRIME-PALLIATIVE CARE-KIDNEY DISEASE-LONG TERM MENTAL HEALTH SUPPORT/COUNSELING-LOW BACK PAIN-PHYSICAL ENVIRONMENT-FLU/PNEUMONIA-LIFE EXPECTANCY/PREMATURE DEATHDUBUIS HOSPITAL OF TEXARKANA WILL FOCUS EFFORTS TO PROVIDE LONG TERM ACUTE CARE SERVICES TO INDIVIDUALS WHO HAVE LIMITED RESOURCES WITH LITTLE OR NO INSURANCE. THE PRIORITIES ARE LIMITED DUE TO LACK OF ADEQUATE RESOURCES AND REGULATORY LIMITATIONS ON THE TYPES OF PATIENTS THAT CAN BE SERVED IN LONG TERM ACUTE CARE FACILITIES. CHARITY CARE WILL BE THE FOCUS OF SERVICES PROVIDED BY DUBUIS HEALTH SYSTEM, INC.
GROUP A-FACILITY 3 -- DUBUIS HOSPITAL OF TEXARKANA - SOUTH PART V, SECTION B, LINE 13H:	TO DETERMINE CHARGES TO PATIENTS, THE FACILITY UTILIZES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES AND OTHER CRITERIA APPLIED TO A UNIFORM FEE SCHEDULE. THE FACILITY HAS IMPLEMENTED A 3 TIER UNINSURED FEE SCHEDULE WHEREIN INDIVIDUALS BETWEEN 201-300% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; INDIVIDUALS BETWEEN 301%-400% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; AND INDIVIDUALS ABOVE 401% OF THE FEDERAL POVERTY LEVEL RECEIVE NO ADDITIONAL DISCOUNT OFF OF THE UNINSURED DISCOUNTED PRICE. THERE IS NO FEDERAL POVERTY LIMIT FOR THE UNINSURED POPULATION TO RECEIVE DISCOUNTED CARE BECAUSE ALL CHARGES BY THE FACILITY ARE BASED ON THE UNINSURED DISCOUNTED PRICE. THE UNINSURED DISCOUNTED PRICE IS BASED ON THE FY 2014 MANAGED CARE AVERAGE REIMBURSEMENT RATE. BASIS FOR DETERMINING CHARGES TO PATIENTSTHE CRITERIA FACTORS FOR CALCULATING CHARGES TO PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE INCLUDES FAMILY SIZE, EMPLOYMENT STATUS AND FUTURE EARNING CAPACITY AND THE AMOUNT AND FREQUENCY OF HOSPITAL/MEDICAL BILLS.
GROUP A-FACILITY 3 -- DUBUIS HOSPITAL OF TEXARKANA - SOUTH PART V, SECTION B, LINE 16I:	HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICYTHE ORGANIZATION'S ONLY OPERATIONS ARE LONG TERM ACUTE CARE SERVICES (LTAC) THAT COMPRISE A FLOOR WITHIN AN EXISTING HOSPITAL(S). AS LTAC FACILITY DOES NOT PROVIDE ON-DEMAND EMERGENCY MEDICAL SERVICES/ELECTIVE TREATMENTS, THE ADMISSIONS PROCESS IS AN ADVANCE SCREENING AND CLINICAL ASSESSMENT DURING WHICH BOTH MEDICAL AND FINANCIAL INFORMATION IS DISCUSSED. IF THERE IS NO INSURANCE COVERAGE FINANCIAL ASSISTANCE IS DISCUSSED AND DETERMINED.
GROUP A-FACILITY 3 -- DUBUIS HOSPITAL OF TEXARKANA - SOUTH PART V, SECTION B, LINE 22D:	TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, LTAC FACILITIES DO NOT PROVIDE EMERGENCY MEDICAL CARE; CHARGES TO FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENTS ARE BASED ON THE AVERAGE MANAGED CARE REIMBURSEMENT RATES FOR THE FISCAL YEAR ENDING JUNE 30, 2013. THE AVERAGE MANAGED CARE RATE IS THE AVERAGE REIMBURSEMENT RECEIVED FOR LTAC SERVICES FROM THE COLLECTIVE GROUP OF PRIVATE INSURERS CONTRACTED WITH CHRISTUS CONTINUING CARE.
GROUP A-FACILITY 4 -- ADVANCE CARE HOSPITAL OF HOT SPRINGS PART V, SECTION B, LINE 5:	IN DEVELOPING THE COMMUNITY HEALTH NEEDS ASSESSMENT, ADVANCE CARE HOSPITAL OF HOT SPRINGS UTILIZED INFORMATION FROM THE HOST HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT, THE U.S. CENSUS, COMMUNITY DISCUSSION WITH HEALTH LEADERS, COUNTY HEALTH RANKINGS, HOSPITAL ADMISSION DATA, AND OTHER AVAILABLE DATA. COMMUNITY LEADERS IN HEALTH CARE PROVIDED FEEDBACK AND PRIORITIZED THE HEALTH NEEDS IDENTIFIED BY THE COMMUNITY.
GROUP A-FACILITY 4 -- ADVANCE CARE HOSPITAL OF HOT SPRINGS PART V, SECTION B, LINE 6A:	BECAUSE ADVANCE CARE HOSPITAL IS LOCATED WITHIN MERCY HOSPITAL OF HOT SPRINGS, AND SERVES THE SAME GEOGRAPHIC MARKET AREA, MANY OF THE FINDINGS THE HOST HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT IS RELEVANT FOR ADVANCE CARE HOSPITAL.
GROUP A-FACILITY 4 -- ADVANCE CARE HOSPITAL OF HOT SPRINGS PART V, SECTION B, LINE 11:	BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED ON BEHALF OF THE HOST HOSPITAL, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AS PRIMARY AREAS OF FOCUS FOR THE SERVICE AREA. UTILIZING INFORMATION FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY MERCY HOSPITAL OF HOT SPRINGS, A TEAM OF INDIVIDUALS REPRESENTING THE MEDICAL AND RELIGIOUS FIELDS REVIEWED THE PRIORITIES ESTABLISHED BY THE HOST HOSPITAL. THE FOLLOWING ARE NEEDS THAT WERE IDENTIFIED AND PRIORITIZED IN THE COMMUNITY: -A WELL-ESTABLISHED CONTINUUM OF CARE FOR THE POOR-ACCESS TO PRIMARY CARE FOR THE POOR-CARE FOR HIGH-RISK CHILDREN-SPECIALTY SERVICES SUCH AS EMERGENCY MEDICINE, TRAUMA, NEUROSURGERY, CANCER CARE, AND CARDIAC SERVICES (HIGH POPULATION OF INDIVIDUALS WITH COPD, HEART DISEASE, AND DIABETES)-ACCESS TO HEALTH CARE FOR HIGH-RISK, LOW-INCOME EXPECTANT MOTHERS-URGENT CARE FOR THE UNINSURED-APPROPRIATE NUTRITION SERVICES (OBESITY WAS CITED AS EXTREME)-PREVENTION SERVICES-CHRONIC CARE FOR THE UNINSURED-IMPROVED SERVICES AND ACCESS TO DRUG ABUSE TREATMENT-VIOLENCE IS ALSO ON THE RISE IN THE COMMUNITY ADVANCE CARE HOSPITAL OF HOT SPRINGS WILL FOCUS EFFORTS TO PROVIDE LONG TERM ACUTE CARE SERVICES TO INDIVIDUALS WHO HAVE LIMITED RESOURCES WITH LITTLE OR NO INSURANCE. THE PRIORITIES ARE LIMITED DUE TO LACK OF ADEQUATE RESOURCES AND REGULATORY LIMITATIONS ON THE TYPES OF PATIENTS THAT CAN BE SERVED IN LONG TERM ACUTE CARE FACILITIES. CHARITY CARE WILL BE THE FOCUS OF SERVICES PROVIDED BY DUBUIS HEALTH SYSTEM, INC.
GROUP A-FACILITY 4 -- ADVANCE CARE HOSPITAL OF HOT SPRINGS PART V, SECTION B, LINE 13H:	TO DETERMINE CHARGES TO PATIENTS, THE FACILITY UTILIZES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES AND OTHER CRITERIA APPLIED TO A UNIFORM FEE SCHEDULE. THE FACILITY HAS IMPLEMENTED A 3 TIER UNINSURED FEE SCHEDULE WHEREIN INDIVIDUALS BETWEEN 201-300% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; INDIVIDUALS BETWEEN 301%-400% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; AND INDIVIDUALS ABOVE 401% OF THE FEDERAL POVERTY LEVEL RECEIVE NO ADDITIONAL DISCOUNT OFF OF THE UNINSURED DISCOUNTED PRICE. THERE IS NO FEDERAL POVERTY LIMIT FOR THE UNINSURED POPULATION TO RECEIVE DISCOUNTED CARE BECAUSE ALL CHARGES BY THE FACILITY ARE BASED ON THE UNINSURED DISCOUNTED PRICE. THE UNINSURED DISCOUNTED PRICE IS BASED ON THE FY 2014 MANAGED CARE AVERAGE REIMBURSEMENT RATE. BASIS FOR DETERMINING CHARGES TO PATIENTSTHE CRITERIA FACTORS FOR CALCULATING CHARGES TO PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE INCLUDES FAMILY SIZE, EMPLOYMENT STATUS AND FUTURE EARNING CAPACITY AND THE AMOUNT AND FREQUENCY OF HOSPITAL/MEDICAL BILLS.
GROUP A-FACILITY 4 -- ADVANCE CARE HOSPITAL OF HOT SPRINGS PART V, SECTION B, LINE 16I:	HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICYTHE ORGANIZATION'S ONLY OPERATIONS ARE LONG TERM ACUTE CARE SERVICES (LTAC) THAT COMPRISE A FLOOR WITHIN AN EXISTING HOSPITAL(S). AS LTAC FACILITY DOES NOT PROVIDE ON-DEMAND EMERGENCY MEDICAL SERVICES/ELECTIVE TREATMENTS, THE ADMISSIONS PROCESS IS AN ADVANCE SCREENING AND CLINICAL ASSESSMENT DURING WHICH BOTH MEDICAL AND FINANCIAL INFORMATION IS DISCUSSED. IF THERE IS NO INSURANCE COVERAGE FINANCIAL ASSISTANCE IS DISCUSSED AND DETERMINED.
GROUP A-FACILITY 4 -- ADVANCE CARE HOSPITAL OF HOT SPRINGS PART V, SECTION B, LINE 22D:	TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, LTAC FACILITIES DO NOT PROVIDE EMERGENCY MEDICAL CARE; CHARGES TO FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENTS ARE BASED ON THE AVERAGE MANAGED CARE REIMBURSEMENT RATES FOR THE FISCAL YEAR ENDING JUNE 30, 2013. THE AVERAGE MANAGED CARE RATE IS THE AVERAGE REIMBURSEMENT RECEIVED FOR LTAC SERVICES FROM THE COLLECTIVE GROUP OF PRIVATE INSURERS CONTRACTED WITH CHRISTUS CONTINUING CARE.
GROUP A-FACILITY 5 -- ADVANCE CARE HOSPITAL OF FORT SMITH PART V, SECTION B, LINE 5:	IN DEVELOPING THE COMMUNITY HEALTH NEEDS ASSESSMENT, ADVANCE CARE HOSPITAL OF FORT SMITH UTILIZED INFORMATION FROM THE HOST HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT, THE U.S. CENSUS, COMMUNITY DISCUSSION WITH HEALTH LEADERS, COUNTY HEALTH RANKINGS, HOSPITAL ADMISSION DATA, AND OTHER AVAILABLE DATA. COMMUNITY LEADERS IN HEALTH CARE PROVIDED FEEDBACK AND PRIORITIZED THE HEALTH NEEDS IDENTIFIED BY THE COMMUNITY.
GROUP A-FACILITY 5 -- ADVANCE CARE HOSPITAL OF FORT SMITH PART V, SECTION B, LINE 6A:	BECAUSE ADVANCE CARE HOSPITAL IS LOCATED WITHIN MERCY HOSPITAL OF FORT SMITH, AND SERVES THE SAME GEOGRAPHIC MARKET AREA, MANY OF THE FINDINGS THE HOST HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT IS RELEVANT FOR ADVANCE CARE HOSPITAL.
GROUP A-FACILITY 5 -- ADVANCE CARE HOSPITAL OF FORT SMITH PART V, SECTION B, LINE 11:	BASED ON THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED ON BEHALF OF THE HOST HOSPITAL, AND A DISCUSSION WITH INDIVIDUALS IN THE COMMUNITY REPRESENTING THE FAITH, HEALTH, AND EDUCATION COMMUNITIES, THE FOLLOWING COMMUNITY HEALTH NEEDS WERE IDENTIFIED AS PRIMARY AREAS OF FOCUS FOR THE SERVICE AREA. -DRUG/ALCOHOL ABUSE -OBESITY/DIABETES/CHF/COPD ETC. -PERVASIVE CULTURE OF POVERTY -LACK OF RESOURCES IN THE COMMUNITY FOR MENTAL HEALTH, HOMELESS, DOMESTIC VIOLENCE, PARENTING, ETC. -LACK OF PERSONAL RESPONSIBILITY/ACCOUNTABILITY ADVANCE CARE HOSPITAL OF FORT SMITH WILL FOCUS EFFORTS TO PROVIDE LONG TERM ACUTE CARE SERVICES TO INDIVIDUALS WHO HAVE LIMITED RESOURCES WITH LITTLE OR NO INSURANCE. THE PRIORITIES ARE LIMITED DUE TO LACK OF ADEQUATE RESOURCES AND REGULATORY LIMITATIONS ON THE TYPES OF PATIENTS THAT CAN BE SERVED IN LONG TERM ACUTE CARE FACILITIES. CHARITY CARE WILL BE THE FOCUS OF SERVICES PROVIDED BY DUBUIS HEALTH SYSTEM, INC.
GROUP A-FACILITY 5 -- ADVANCE CARE HOSPITAL OF FORT SMITH PART V, SECTION B, LINE 13H:	TO DETERMINE CHARGES TO PATIENTS, THE FACILITY UTILIZES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES AND OTHER CRITERIA APPLIED TO A UNIFORM FEE SCHEDULE. THE FACILITY HAS IMPLEMENTED A 3 TIER UNINSURED FEE SCHEDULE WHEREIN INDIVIDUALS BETWEEN 201-300% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; INDIVIDUALS BETWEEN 301%-400% OF THE FEDERAL POVERTY LEVEL RECEIVE A SPECIFIC DISCOUNT PERCENTAGE OFF OF THE UNINSURED DISCOUNTED PRICE; AND INDIVIDUALS ABOVE 401% OF THE FEDERAL POVERTY LEVEL RECEIVE NO ADDITIONAL DISCOUNT OFF OF THE UNINSURED DISCOUNTED PRICE. THERE IS NO FEDERAL POVERTY LIMIT FOR THE UNINSURED POPULATION TO RECEIVE DISCOUNTED CARE BECAUSE ALL CHARGES BY THE FACILITY ARE BASED ON THE UNINSURED DISCOUNTED PRICE. THE UNINSURED DISCOUNTED PRICE IS BASED ON THE FY 2014 MANAGED CARE AVERAGE REIMBURSEMENT RATE. BASIS FOR DETERMINING CHARGES TO PATIENTSTHE CRITERIA FACTORS FOR CALCULATING CHARGES TO PATIENTS QUALIFIED FOR FINANCIAL ASSISTANCE INCLUDES FAMILY SIZE, EMPLOYMENT STATUS AND FUTURE EARNING CAPACITY AND THE AMOUNT AND FREQUENCY OF HOSPITAL/MEDICAL BILLS.
GROUP A-FACILITY 5 -- ADVANCE CARE HOSPITAL OF FORT SMITH PART V, SECTION B, LINE 16I:	HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICYTHE ORGANIZATION'S ONLY OPERATIONS ARE LONG TERM ACUTE CARE SERVICES (LTAC) THAT COMPRISE A FLOOR WITHIN AN EXISTING HOSPITAL(S). AS LTAC FACILITY DOES NOT PROVIDE ON-DEMAND EMERGENCY MEDICAL SERVICES/ELECTIVE TREATMENTS, THE ADMISSIONS PROCESS IS AN ADVANCE SCREENING AND CLINICAL ASSESSMENT DURING WHICH BOTH MEDICAL AND FINANCIAL INFORMATION IS DISCUSSED. IF THERE IS NO INSURANCE COVERAGE FINANCIAL ASSISTANCE IS DISCUSSED AND DETERMINED.
GROUP A-FACILITY 5 -- ADVANCE CARE HOSPITAL OF FORT SMITH PART V, SECTION B, LINE 22D:	TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, LTAC FACILITIES DO NOT PROVIDE EMERGENCY MEDICAL CARE; CHARGES TO FINANCIAL ASSISTANCE POLICY ELIGIBLE PATIENTS ARE BASED ON THE AVERAGE MANAGED CARE REIMBURSEMENT RATES FOR THE FISCAL YEAR ENDING JUNE 30, 2013. THE AVERAGE MANAGED CARE RATE IS THE AVERAGE REIMBURSEMENT RECEIVED FOR LTAC SERVICES FROM THE COLLECTIVE GROUP OF PRIVATE INSURERS CONTRACTED WITH CHRISTUS CONTINUING CARE.

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 6A:	A REPORT OF COMMUNITY BENEFIT IS INCLUDED IN A WRITTEN ANNUAL REPORT FOR CHRISTUS HEALTH, THE ORGANIZATION'S PARENT COMPANY. CHRISTUS HEALTH IS AN INTERNATIONAL, CATHOLIC, FAITH BASED HEALTH SYSTEM FORMED IN 1999 WITH A MISSION "TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST". THE ANNUAL COMMUNITY BENEFIT REPORT SUMMARIZES ACTIVITIES AND PROGRAMS CONDUCTED DURING THE PAST YEAR TO IMPROVE HEALTH INCLUDING PROACTIVE COMMUNITY HEALTH SERVICES. HOWEVER, THE ANNUAL REPORT IS ONLY A SNAPSHOT OF HOW THE ORGANIZATION DISTINGUISHES ITSELF IN ITS VISION TO BE A LEADER, A PARTNER, AND AN ADVOCATE IN CREATING INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND COMMUNITIES.
PART I, LINE 7:	THE COMMUNITY BENEFIT COST OF CHARITY CARE WAS CALCULATED AS THE TOTAL VOLUNTARY FREE CARE TIMES THE RATIO OF COST TO GROSS PATIENT BILLING. THE COMMUNITY BENEFIT OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS WAS CALCULATED AS GROSS MEDICAID BILLING TIMES THE RATIO OF COST TO GROSS PATIENT BILLING. THE ASSOCIATED REVENUE OF OTHER MEANS-TESTED GOVERNMENT PROGRAMS IS NET OF MEDICAID REVENUE AND THE DENOMINATOR WAS ADJUSTED FOR BAD DEBT EXPENSE. THE TOTAL COMMUNITY BENEFIT EXPENSE FOR COMMUNITY HEALTH IMPROVEMENT SERVICES AND HEALTH PROFESSIONALS EDUCATION WAS ACCUMULATED ON A PROJECT BY PROJECT BASIS USING DIRECT COSTING. THE COMMUNITY BENEFIT FOR IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS WAS ESTIMATED BASED ON SQUARE FOOTAGE CONTRIBUTED AND ACTUAL FACILITY SPACE COST.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 116,021.
PART III, LINE 4:	PATIENT ACCOUNTS RECEIVABLE ARE FROM PATIENTS AND THIRD-PARTY PAYORS FOR MEDICAL SERVICES AND ARE REPORTED AT THEIR NET COLLECTIBLE VALUE, NET OF ALLOWANCES FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS. ALLOWANCES ARE ESTIMATED BASED ON ESTABLISHED BILLING RATES, HISTORICAL EXPERIENCE, CHANGES IN PAYOR MIX, CASH COLLECTIONS, WRITE-OFFS, AND MARKET DYNAMICS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, DUBUIS HEALTH SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), DUBUIS HEALTH SYSTEM RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IT IS POSSIBLE THAT MANAGEMENT'S ESTIMATE REGARDING COLLECTABILITY WILL CHANGE IN THE NEAR TERM RESULTING IN A CHANGE IN THE CARRYING VALUE OF PATIENT ACCOUNTS RECEIVABLE. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY WAS APPROXIMATELY $280,906 AT JUNE 30, 2015 COMPARED TO APPROXIMATELY $281,000 AT JUNE 30, 2014. DUBUIS HEALTH SYSTEM HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL 2015 AND 2014. DUBUIS HEALTH SYSTEM DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS.
PART III, LINE 8:	THE SHORTFALL REPORTED IN LINE 7 IS NOT TREATED AS COMMUNITY BENEFIT. THE AMOUNT ON SCHEDULE H, PART III, LINE 6 IS DETERMINED BY CALCULATING MEDICARE ALLOWABLE COSTS USING WORKSHEET A OF THE MEDICARE COST REPORT. WORKSHEET A OF THE MEDICARE COST REPORT REQUIRES THE ORGANIZATION TO REMOVE NON-ALLOWABLE EXPENSES FROM TOTAL EXPENSES VIA THE ADJUSTMENTS TO EXPENSES WORKSHEETS WITH THE MEDICARE COST REPORT.
PART III, LINE 9B:	THE FILING ORGANIZATION DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARTY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INABILITY TO PAY. PATIENTS THAT ARE UNABLE TO PAY ARE PROVIDED CHARITY CARE INFOMRATION. UPON ADMISSION, PATIETNS WHO HAVE NO INSURANCE COVERAGE AND NO ABILITY TO PAY WILL BE GIVEN CONSIDERATION FOR CHARITY CARE. EVERY EFFORT WILL BE MADE TO OBTAIN THE APPROPRIATE FINANCIAL DOCUMENTATION TO DETERMINE THE ABILITY TO PAY FOR SERVICES.
PART VI, LINE 2:	ALL PATIENTS ARE ASSESSED DURING THE REGISTRATION PROCESS. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM BUT ARE NOT CURRENTLY ENROLLED ARE REFERRED TO THE APPROPRIATE PROGRAM. PATIENTS WHO CAN PROVE ELIGIBILITY FOR MEDICAID WILL BE DEEMED AS INDIGENT AND AUTOMATICALLY QUALIFY FOR CHARITY CARE. PATIENTS ADMITTED TO THE HOSPITAL WITH MEDICARE AS THE ONLY INSURANCE WILL BE MONITORED AS MEDICARE DAYS NEAR DEPLETION. THIRTY DAYS PRIOR TO THE END OF THE MEDICARE COVERAGE, AN INTERVIEW AND AN APPLICATION FOR FINANCIAL ASSISTANCE WILL BE REQUESTED AS APPROPRIATE. THESE PATIENTS ARE ASSESSED AS TO MEETING THE GUIDELINES FOR RECEIVING CHARITY CARE IF THE STAY SHOULD EXCEED MEDICARE COVERAGE LIMITS. AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORT IS PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATIONS ARE MADE.
PART VI, LINE 3:	DUBUIS HEALTH SYSTEM MAKES EVERY EFFORT TO EDUCATE PATIENTS ON ITS CHARITY AND DISCOUNT POLICY AND ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS DURING THE REGISTRATION PROCESS. IN ADDITION, A PUBLIC NOTICE IS POSTED REGARDING THE CHARITY CARE POLICY AND INFORMATION ON FINANCIAL ASSISTANCE INCLUDES EXPLANATIONS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY FOR FINANCIAL ASSISTANCE. AFTER THE REGISTRATION PROCESS, PATIENTS THAT ARE UNABLE TO PAY ARE PROVIDED CHARITY CARE INFORMATION.
PART VI, LINE 4:	DUBUIS HEALTH SYSTEM HAS SERVICE AREAS IN TEXAS AND ARKANSAS. THE TEXAS SERVICE AREA INCLUDES LONG-TERM ACUTE CARE FACILITIES LOCATED IN CORPUS CHRISTI AND TEXARKANA. THE ARKANSAS SERVICE AREA INCLUDES LONG-TERM ACUTE CARE FACILITIES LOCATED IN HOT SPRINGS AND FORT SMITH. THE ORGANIZATION'S TEXARKANA, TEXAS SERVICE AREA SERVES AND SERVICES NORTHEAST TEXAS, NORTHWEST LOUISIANA, SOUTHWEST ARKANSAS, AND SOUTHEAST OKLAHOMA, WHICH COVERS A POPULATION OF APPROXIMATELY 338,000 PERSONS. TEXARKANA, TEXAS AND TEXARKANA, ARKANSAS ARE THE LARGEST CITIES IN THE REGION, MAKING UP APPROXIMATELY 50 PERCENT OF THE TOTAL POPULATION. THEY ARE LOCATED IN BOWIE AND MILLER COUNTIES, RESPECTIVELY. BOTH COUNTIES FALL BELOW THE STATE'S MEDIAN HOUSEHOLD INCOME, AND HAVE AN APPROXIMATE POPULATION OF 14.1% OF PERSONS AGES 65 AND OLDER. CORPUS CHRISTI, TEXAS SERVICE AREA IS LOCATED ALONG THE LOWER TEXAS COASTAL AREA (OFTEN CALLED THE COASTAL BEND), AND ITS SERVICE AREA INCLUDES A 14-COUNTY AREA WITH A POPULATION OF MORE THAN 602,000 INDIVIDUALS. APPROXIMATELY 11.9% OF THE POPULATION IS COMPOSED OF PERSONS AGES 65 AND OVER, AND THE LARGEST GROWTH IS IN THIS AGE GROUP. APPROXIMATELY 18.2% OF PERSONS IN THE REGION LIVE AT OR BELOW THE FEDERAL POVERTY LEVEL, WITH THE MEDIAN HOUSEHOLD INCOME IN THE REGION BEING APPROXIMATELY $47,481. NEARLY 50 PERCENT OF THE POPULATION IS ON MEDICAID OR UNINSURED. ADVANCE CARE HOSPITAL'S SERVICE AREAS IN ARKANSAS INCLUDE LONG-TERM ACUTE CARE HOSPITALS IN FORT SMITH AND HOT SPRINGS. THE ADVANCE CARE HOSPITAL COMMUNUITY IS COMPRISED OF PATIENTS FROM LOCAL COMMUNITIES WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPHY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. SPECIAL EFFORTS ARE TAKEN TO ENSURE THAT POOR AND OTHER UNDERSERVED INDIVIDUALS ARE INCLUDED IN THE COMMUNITY SERVED. ADVANCE CARE HOSPITAL OF FORT SMITH IS LOCATED IN SEBASTIAN COUNTY. TOTAL POPULATION IN THE COUNTY IS 127,342 OF WHICH 14.1% ARE AGES 65 AND OVER ACCORDING TO THE 2013 CENSUS BUREAU. IN ADDITION, 20.0% OF THE POPULATION IS BELOW THE POVERTY LEVEL. ADVANCE CARE HOSPITAL OF HOT SPRINGS IS LOCATED IN GARLAND COUNTY. TOTAL POPULATION IN THE COUNTY IS 97,173 OF WHICH 21.3% ARE AGE 65 AND OVER ACCORDING TO THE 2013 CENSUS BUREAU. IN ADDITION, 19.8% OF THE POPULATION IS BELOW POVERTY LEVEL.
PART VI, LINE 5:	DUBUIS HEALTH SYSTEM IS COMPRISED OF LONG TERM ACUTE CARE (LTACH) HOSPITALS - DUBUIS HOSPITAL OF CORPUS CHRISTI, DUBUIS HOSPITAL OF TEXARKANA, ADVANCE CARE HOSPITAL OF HOT SPRINGS, AND ADVANCE CARE HOSPITAL OF FORT SMITH.THE COMPASSION OF THE DUBUIS HEALTH SYSTEM ASSOCIATES REACHES FAR BEYOND THE WALLS OF OUR FACILITIES. EACH YEAR, OUR ASSOCIATES VOLUNTEER NUMEROUS HOURS AND PROVIDE SERVICES FOR THE BETTERMENT OF THE COMMUNITIES WE SERVE. AS WE MOVE TOWARD THE FUTURE, WE AT DUBUIS HEALTH SYSTEM ARE FOREVER MINDFUL OF OUR PAST. FOR IT IS THE TRADITION OF BISHOP DUBUIS AND THE SISTERS THAT EMPOWERS US TO CONTINUE THIS HEALING MINISTRY. AND IT IS THEIR LEGACY OF JUSTICE, COMPASSION AND TRUST THAT, IN PARTNERSHIP WITH GOD, HELPS US CREATE OUR UNIQUE ENVIRONMENT, THE HEALING ENVIRONMENT THAT IS DUBUIS HEALTH SYSTEM. DUBUIS HEALTH SYSTEM COMMITS SIGNIFICANT TIME AND RESOURCES TO HEALTH CARE PROGRAMS AND SERVICES ESTABLISHED SPECIFICALLY TO MEET THE NEEDS OF THE COMMUNITY WITH MINIMAL OR NO RESOURCES.IN ADDITION TO THE PROVISION OF LONG TERM INPATIENT CARE, DUBUIS HEALTH SYSTEM HAS FULFILLED ITS EXEMPT PURPOSES THROUGH A VARIETY OF OTHER MEANS. THESE INCLUDE, BUT ARE NOT LIMITED TO, PRESENTATIONS AND LECTURES ON HEALTH EDUCATION RELATED TOPICS TO ADULT AND STUDENT YOUTH GROUPS, PROVISION OF SPACE AT NO CHARGE FOR RECOGNIZED SELF-HELP GROUPS, PROGRAMS TO ENCOURAGE THE PURSUIT OF NURSING AND OTHER MEDICAL CAREERS, GENERAL MEDICAL INFORMATION RESOURCES PROVIDED TO THE GENERAL PUBLIC THROUGH THE ORGANIZATION'S WEBSITE, DONATIONS BY EMPLOYEES TO SUPPORT CHARITIES AND OTHER ORGANIZATIONS, AND MEMBERS OF LEADERSHIP SPEND PAID TIME ON LOCAL NONPROFIT BOARDS.
PART VI, LINE 6:	DUBUIS HEALTH SYSTEM IS SPONSORED BY CHRISTUS HEALTH, AN INTERNATIONAL CATHOLIC, FAITH-BASED NONPROFIT HEALTH SYSTEM COMPRISED OF NEARLY 350 SERVICES AND FACILITIES INCLUDING MORE THAN 50 HOSPITALS AND LONG-TERM CARE FACILITIES, 175 CLINICS AND OUTPATIENT CENTERS, AND OTHER COMMUNITY HEALTH MINISTRIES AND COMMUNITY DEVELOPMENT VENTURES. CHRISTUS SERVES AREAS IN ARKANSAS, GEORGIA, IOWA, LOUISIANA, NEW MEXICO, TEXAS AND SIX PROVINCES OF MEXICO. EACH ORGANIZATION DEVELOPS FIVE-YEAR AND TEN-YEAR STRATEGIC PLANS THAT HELP ESTABLISH ANNUAL PLANS AND BUDGETS. THE AFFILIATED ORGANIZATIONS' STRATEGIC GOALS ARE DEVELOPED IN COLLABORATION WITH CHRISTUS HEALTH INCLUDING METRICS THAT WILL BE USED TO MEASURE COMMUNITY BENEFIT, CLINICAL OUTCOMES, PATIENT SATISFACTION AND ASSOCIATE ENGAGEMENT. CHRISTUS HEALTH PROVIDES UPDATED MARKET DEMOGRAPHICS AND HEALTH INDICATOR STATISTICS ON AN ANNUAL BASIS.
PART VI, LINE 7, REPORTS FILED WITH STATES	TX,LA,AR

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JAN HAMILTON-CRAWFORDPRESIDENT (EFF. DATE 5/4/15)	(i) (ii)	0 ............................... 188,931	0 ............................... 68,171	0 ............................... 38,240	0 ............................... 19,535	0 ............................... 7,234	0 ............................... 322,111	0 ............................... 0
2RANDY SAFADYBOARD MEMBER	(i) (ii)	0 ............................... 913,874	0 ............................... 572,507	0 ............................... 259,347	0 ............................... 354,559	0 ............................... 20,702	0 ............................... 2,120,989	0 ............................... 124,222
3PAUL GENERALEBOARD MEMBER	(i) (ii)	0 ............................... 642,999	0 ............................... 360,041	0 ............................... 115,681	0 ............................... 289,232	0 ............................... 21,082	0 ............................... 1,429,035	0 ............................... 71,321
4MIKE MURRAYCFO	(i) (ii)	0 ............................... 177,465	0 ............................... 68,162	0 ............................... 26,735	0 ............................... 51,277	0 ............................... 24,395	0 ............................... 348,034	0 ............................... 25,295
5HOLLY POWELLADMINISTRATOR	(i) (ii)	116,761 ............................... 0	28,583 ............................... 0	15,403 ............................... 0	2,254 ............................... 0	20,509 ............................... 0	183,510 ............................... 0	0 ............................... 0
6FIONA ADAMSREG. CLIN. ADMINISTRATOR	(i) (ii)	218,249 ............................... 0	4,000 ............................... 0	7,848 ............................... 0	23,000 ............................... 0	1,185 ............................... 0	254,282 ............................... 0	0 ............................... 0
7DIANE KAISERADMINISTRATOR	(i) (ii)	175,253 ............................... 0	5,000 ............................... 0	27,169 ............................... 0	17,500 ............................... 0	5,241 ............................... 0	230,163 ............................... 0	0 ............................... 0
8SAM BARKMANVP OF STRATEGIC INITIATIVES	(i) (ii)	187,447 ............................... 0	0 ............................... 0	38,711 ............................... 0	1,648 ............................... 0	1,745 ............................... 0	229,551 ............................... 0	0 ............................... 0
9STEPHEN A MILLSFORMER OFFICER	(i) (ii)	267,765 ............................... 0	0 ............................... 0	50,204 ............................... 0	0 ............................... 0	1,138 ............................... 0	319,107 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 1A	THE CEO OF DUBUIS HEALTH SYSTEM, INC AND ALL OTHER OFFICERS AND BOARD OF DIRECTORS ARE ENTITLED TO REIMBURSEMENT FOR COMPANION TRAVEL TO BUSINESS RELATED EVENTS. THE REIMBURSEMENT IS SUBJECT TO CLAIMS REPORT PROCESSES, AND IS APPROVED BY THE VICE PRESIDENT OF HR, CONTROLLER, AND THE CHAIRMAN OF THE BOARD OF DIRECTORS.
PART I, LINE 4A	SEVERANCE COMPENSATION WAS PAID TO THE FOLLOWING PERSONS: MATTHEW E. SMITH - $109,907.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE N
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Liquidation, Termination, Dissolution, or Significant Disposition of Assets

Complete if the organization answered "Yes" to Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
bullet

Attach certified copies of any articles of dissolution, resolutions, or plans.
bullet

Attach to Form 990 or 990-EZ.
bullet

Information about Schedule N (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
DUBUIS HEALTH SYSTEM INC

Employer identification number
72-1270964

Part I

Liquidation, Termination, or Dissolution. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.

1(a)Description of asset(s) distributed or transaction expenses paid	(b)Date of distribution	(c)Fair market value of asset(s) distributed or amount of transaction expenses	(d)Method of determining FMV for asset(s) distributed or transaction expenses	(e)EIN of recipient	(f)Name and address of recipient	(g)IRC section of recipient(s) (if tax-exempt) or type of entity

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .

Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . .

Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? . . . . .

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.

Cat. No. 50087Z

Schedule N (Form 990 or 990-EZ) (2014)

Page 2

Part I

Liquidation, Termination, or Dissolution (continued)

Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.

Yes

Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III . . . . . . . . . . .

Yes

Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . . .

If "Yes," did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . .

Yes

Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . .

If "Yes" to line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?

If "Yes" to line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If "No" to line 6b, explain in Part III.

Part II

Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization's Assets. Complete this part if the organization answered "Yes" to Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.

1(a) Description of asset(s) distributed or transaction expenses paid	(b) Date of distribution	(c) Fair market value of asset(s) distributed or amount of transaction expenses	(d) Method of determining FMV for asset(s) distributed or transaction expenses	(e) EIN of recipient	(f) Name and address of recipient	(g) IRC section of recipient(s) (if tax-exempt) or type of entity
DUBUIS HOSPITAL OF TEXARKANA - NORTH - PP&E AND INVENTORY	11-02-2014	1,456,025	SALE PRICE	47-1646382	PAM SQUARED AT TEXARKANA LLC 1828 GOOD HOPE ROAD SUITE 102 ENOLA,PA17025	LLC
DUBUIS HOSPITAL OF TEXARKANA - SOUTH - PP&E AND INVENTORY	11-02-2014	1,816,864	SALE PRICE	47-1646382	PAM SQUARED AT TEXARKANA LLC 1828 GOOD HOPE ROAD SUITE 102 ENOLA,PA17025	LLC
DUBUIS HOSPITAL OF CORPUS CHRISTI - PP&E AND INVENTORY	11-02-2014	1,721,597	SALE PRICE	47-1678394	PAM SQUARED AT CORPUS CHRISTI LLC 1828 GOOD HOPE ROAD SUITE 102 ENOLA,PA17025	LLC
ADVANCE CARE HOSPITAL OF HOT SPRINGS - NET ASSETS	08-31-2014	865,645	BOOK VALUE	74-2898615	CHRISTUS CONTINUING CARE 919 HIDDEN RIDGE IRVING,TX75038	501(C)(3)
ADVANCE CARE HOSPITAL OF FORT SMITH - NET ASSETS	08-31-2014	643,355	BOOK VALUE	74-2898615	CHRISTUS CONTINUING CARE 919 HIDDEN RIDGE IRVING,TX75038	501(C)(3)

Yes

Did or will any officer, director, trustee, or key employee of the organization:

Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .

Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .

Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . . . . . . .

If the organization answered "Yes" to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III. bullet

Schedule N(Form 990 or 990-EZ) (2014)

Schedule N (Form 990 or 990-EZ) (2014)

Page 3

Part III

Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e. Also complete this part to provide any additional information.

Return Reference	Explanation
PART II, LINE 2E:	PERSON(S) INVOLVED: HOLLY POWELL BECAME AN EMPLOYEE OF PAM SQUARED AT TEXARKANA, LLC AFTER THE TRANSACTION DESCRIBED IN PART II, LINE 1.
PART II, LINE 2E:	PERSON(S) INVOLVED: FIONA ADAMS BECAME AN EMPLOYEE OF PAM SQUARED AT TEXARKANA, LLC AFTER THE TRANSACTION DESCRIBED IN PART II, LINE 1.

Schedule N (Form 990 or 990-EZ) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Return Reference	Explanation
FORM 990, PART III, LINE 3	DUBUIS HEALTH SYSTEM, INC. OPERATED 5 HOSPITAL FACILITIES AT THE BEGINNING OF ITS 2014 TAX YEAR, WHICH ENDED JUNE 30, 2015. TWO HOSPITAL FACILITIES WERE SOLD IN AUGUST OF 2014. ON NOVEMBER 3, 2014, SUBSTANTIALLY ALL OF THE OPERATING ASSETS OF DUBUIS HEALTH SYSTEM, INC.'S THREE REMAINING LONG TERM ACUTE CARE HOSPITALS WERE SOLD. AS A RESULT OF THESE TRANSACTIONS, DUBUIS HEALTH SYSTEM, INC. HAS CEASED TO PROVIDE POST ACUTE INPATIENT SERVICES OR OPERATE HOSPITAL FACILITIES AS OF NOVEMBER 3, 2014.
FORM 990, PART IV, LINE 20B:	FOR THE FISCAL YEAR ENDED JUNE 30, 2015, NO AUDIT WAS PERFORMED DUE TO CEASED FACILITY OPERATIONS AS DESCRIBED IN THE SCHEDULE O RESPONSE TO 990 PART III, LINE 3. THE MOST RECENT AUDITED FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2014 AND 2013 ARE ATTACHED.
FORM 990, PART VI, SECTION A, LINE 1	EFFECTIVE MAY 4, 2015: CHRISTUS HEALTH, THE SOLE CORPORATE MEMBER, DELEGATED ITS AUTHORITY OF APPROVAL OR DISAPPROVAL OF THE DUBUIS HEALTH SYSTEM, INC. MATTERS DESCRIBED IN BELOW RESPONSE TO 990 PART VI, LINE 7B TO THE PRESIDENT OF CHRISTUS HEALTH OR HIS/HER DESIGNEE.
FORM 990, PART VI, SECTION A, LINE 3	DUBUIS HEALTH SYSTEM, INC. ENTERED INTO A MANAGEMENT AGREEMENT WITH CHRISTUS CONTINUING CARE (CCC) EFFECTIVE JULY 1, 2009.
FORM 990, PART VI, SECTION A, LINE 4	EFFECTIVE MAY 4, 2015, THE BYLAWS OF DUBUIS HEALTH SYSTEM, INC. WERE AMENDED TO INCLUDE THE FOLLOWING SIGNIFICANT CHANGES: - NUMBER AND COMPOSITION OF DIRECTORS: THE NUMBER OF DIRECTORS SHALL BE NOT LESS THAN THREE AND NO MORE THAN SIX. THE CORPORATE MEMBER SHALL APPOINT ALL DIRECTORS. DIRECTORS SHALL SERVE TERMS OF ONE YEAR. - RESIGNATION AND REMOVAL: ANY DIRECTOR MAY BE REMOVED AT ANY TIME BY ACTION OF THE CORPORATE MEMBER. - QUORUM A MAJORITY OF THE BOARD THEN IN OFFICE, BUT NOT LESS THAN TWO, SHALL CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS AT ANY MEETING OF THE BOARD. - FORMAL ACTIONS BY DIRECTORS THE ACT OF MAJORITY VOTE OF THE DIRECTORS PRESENT AT A MEETING AT WHICH QUORUM IS PRESENT SHALL BE AN ACT OF THE BOARD. - ACTIONS WITHOUT MEETING ACTIONS BY THE BOARD MAY BE TAKEN WITHOUT MEETING IF WRITTEN CONSENT SETTING FORTH THE ACTION IS SIGNED BY ALL DIRECTORS. DIRECTORS MAY PROVIDE CONSENT VIA EMAIL. - VOTING AT ANY MEETING, A PERSON ENTITLED TO VOTE MAY VOTE IN PERSON OR BY ORAL VOTE VIA TELECOMMUNICATION LINKAGE. - COMPENSATION DIRECTORS SHALL NOT RECEIVE ANY SALARIES FOR SERVICES IN THEIR CAPACITIES AS DIRECTORS. DIRECTORS MAY SERVE THE CORPORATION, THE CORPORATE MEMBER, ITS SUBSIDIARIES OR AFFILIATES IN ANY OTHER CAPACITY OTHER THAN AS DIRECTOR AND RECEIVE REASONABLE COMPENSATION THEREFOR. - APPOINTMENT, REMOVAL AND TENURE OF OFFICERS THE OFFICERS OF THE CORPORATION SHALL BE A PRESIDENT, A SECRETARY AND A TREASURER AND SUCH OTHER OFFICERS AS THE PRESIDENT MAY FROM TIME TO TIME DETERMINE TO BE NECESSARY OR CONVENIENT. THE OFFICERS, OTHER THAN THE PRESIDENT, SHALL BE APPOINTED BY THE BOARD AT ITS ANNUAL MEETING. THE CORPORATION'S PRESIDENT SHALL BE ELECTED BY THE CORPORATE MEMBER'S CHIEF EXECUTIVE OFFICER. EACH OFFICER, OTHER THAN PRESIDENT, SHALL HOLD OFFICE UNTIL THE NEXT ANNUAL MEETING OF THE BOARD OR UNTIL HIS/HER SUCCESSOR SHALL BE APPOINTED.
FORM 990, PART VI, SECTION A, LINE 6	CHRISTUS HEALTH IS THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	PRIOR TO MAY 4, 2015: CHRISTUS HEALTH, THE SOLE MEMBER, IS PERMITTED TO ELECT A NUMBER OF BOARD MEMBERS EQUAL TO THE NUMBER OF BOARD MEMBERS ELECTED DIRECTLY BY MAJORITY VOTE OF THE BOARD OF DIRECTORS. A LIST OF QUALIFIED CANDIDATES NOMINATED FOR OFFICE BY THE BOARD OF THE CORPORATION IS PROVIDED TO CHRISTUS HEALTH FROM WHICH THEY MAY CHOOSE THE BOARD MEMBERS THEY WISH TO ELECT. EFFECTIVE MAY 4, 2015 CHRISTUS HEALTH, THE SOLE CORPORATE MEMBER, IS PERMITTED TO APPOINT ALL BOARD MEMBERS. THE NUMBER OF BOARD MEMBERS SHALL NOT BE LESS THAN 3 AND NO MORE THAN 6. ANY BOARD MEMBER MAY BE REMOVED AT ANY TIME BY ACTION OF CHRISTUS HEALTH, AS THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	THE BYLAWS OF THE CORPORATION STATE THAT THE CORPORATE MEMBER (CHRISTUS HEALTH) MUST APPROVE THE FOLLOWING ACTIONS: ANY AMENDMENT, MODIFICATION OR RESTATEMENT OF THE BYLAWS OR THE CORPORATION'S ARTICLES OF INCORPORATION; ANY ACTION OR INACTION AT VARIANCE WITH ANY POLICIES OF THE CORPORATE MEMBER MADE APPLICABLE TO THE CORPORATION EXCEPT FOR THE CORPORATION'S OR ANY HOSPITAL'S MANAGEMENT AND OPERATIONS; ANY CREATION OR ACQUISITION OF OTHER CORPORATIONS OR BUSINESS ENTITIES BY THE CORPORATION; ANY SALE, LEASE, MORTGAGE OR OTHER TRANSFER OR ENCUMBRANCE OF THE REAL PROPERTY OF ANY HOSPITAL OR THE CORPORATION AND ANY MERGER, CONSOLIDATION, LIQUIDATION OR DISSOLUTION OF THE CORPORATION; IN THE EVENT THE CORPORATION HAS OUTSTANDING INDEBTEDNESS TO THE CORPORATE MEMBER, ANY LONG-TERM BORROWING, LOAN OR LEASE FINANCING IN EXCESS OF $250,000; ANY MATTERS STATED IN THE BYLAWS AS RESERVED FOR APPROVAL BY THE CORPORATE MEMBER, OR REQUIRED BY LAW TO BE SUBMITTED TO THE CORPORATE MEMBER, OR AS TO WHICH THE PRESIDENT OR THE BOARD DETERMINES THAT SUBMISSION IS ADVISABLE. EFFECTIVE MAY 4, 2015: CHRISTUS HEALTH, THE SOLE CORPORATE MEMBER, DELEGATED ITS AUTHORITY OF APPROVAL OR DISAPPROVAL OF THE DUBUIS HEALTH SYSTEM, INC. MATTERS DESCRIBED IN ABOVE RESPONSE TO 990 PART VI, LINE 7B TO THE PRESIDENT OF CHRISTUS HEALTH OR HIS/HER DESIGNEE.
FORM 990, PART VI, SECTION A, LINE 8B	DUBUIS HEALTH SYSTEM, INC. DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11	THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM 990 BY THE INDEPENDENT ACCOUNTING FIRM, THE 990 IS SUBMITTED TO THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATION MAINTAINS SEPARATE CONFLICT OF INTEREST POLICIES FOR EMPLOYEES OF THE ORGANIZATION AND FOR THE MEMBERS OF THE BOARD OF DIRECTORS. BOTH POLICIES REQUIRE ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE EMPLOYEE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURE IS REVIEWED BY THE EMPLOYEE'S IMMEDIATE SUPERVISOR. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE ORGANIZATION'S ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, THE ORGANIZATION IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY THE ORGANIZATION UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS.
FORM 990, PART VI, SECTION B, LINE 15A	COMPENSATION FOR TONI MILLS, CEO THROUGH 5/4/2015, WAS APPROVED BY THE BOARD OF DIRECTORS DURING THE YEAR AND WAS BASED ON AN INDEPENDENT STUDY PREPARED BY SULLIVAN COTTER. MIKE MURRAY, TREASUER, IS NOT COMPENSATED BY THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC FROM THE LOUISIANA SECRETARY OF STATE.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

DUBUIS HEALTH SYSTEM INC

Employer identification number

72-1270964

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) CHRISTUS HEALTH 919 HIDDEN RIDGE DRIVE IRVING,TX75038 76-0590551	SUPPORT HEALTHCARE FACILITIES	TX	501(C)(3)	LINE 9	N/A		No
(2) CHRISTUS HEALTH ARK-LA-TEX 2600 ST MICHAEL DR TEXARKANA,TX75503 75-2796815	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(3) CHRISTUS HEALTH CENTRAL LOUISIANA 3330 MASONIC DR ALEXANDRIA,LA71301 72-0408984	HEALTHCARE SERVICES	LA	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(4) CHRISTUS HEALTH NORTHERN LOUISIANA ONE ST MARY PLACE SHREVEPORT,LA71101 72-0408982	HEALTHCARE SERVICES	LA	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(5) CHRISTUS SPOHN HEALTH SYSTEM CORPORATION 600 ELIZABETH STREET CORPUS CHRISTI,TX78404 74-1109836	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(6) CHRISTUS HEALTH GULF COAST PO BOX 922037 HOUSTON,TX77292 76-0591592	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(7) CHRISTUS HEALTH SOUTHEAST TEXAS 2830 CALDER ST BEAUMONT,TX77726 76-0591590	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(8) CHRISTUS HEALTH SOUTHWESTERN LOUISIANA 524 DR MICHAEL DEBAKEY DRIVE LAKE CHARLES,LA70601 72-0411322	HEALTHCARE SERVICES	LA	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(9) CHRISTUS SANTA ROSA HEALTH CARE CORP 333 N SANTA ROSA STREET SAN ANTONIO,TX78207 74-1109665	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(10) CHRISTUS HEALTH FOUNDATION 919 HIDDEN RIDGE DRIVE IRVING,TX75038 61-1500100	SUPP HTH SVCS	TX	501(C)(3)	LINE 11, TYPE I: 509	CH		No
(11) CHRISTUS HEALTH LIABILITY RETENTION TRUST 919 HIDDEN RIDGE DRIVE IRVING,TX75038 76-0259623	SELF INS TRST	TX	501(C)(3)	LINE 11, TYPE I: 509	CH		No
(12) CHRISTUS HEALTH STRATEGIC GROWTH 919 HIDDEN RIDGE DRIVE IRVING,TX75038 46-2798043	SUPP HTH SVCS	TX	501(C)(3)	LINE 11, TYPE I: 509	CH		No
(13) CHRISTUS HEALTH PLAN LOUISIANA 919 HIDDEN RIDGE DRIVE IRVING,TX75038 46-4617988	MEDICAID HMO	LA	501(C)(3)	LINE 9	CH		No
(14) CHRISTUS HEALTH PLAN NEW MEXICO 919 HIDDEN RIDGE DRIVE IRVING,TX75038 46-4487295	MEDICAID HMO	NM	501(C)(3)	LINE 9	CH		No
(15) CHRISTUS PEDIATRIC PHYSICIAN GROUP 919 HIDDEN RIDGE DRIVE IRVING,TX75038 46-5203505	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No
(16) CHRISTUS FOUNDATION FOR HEALTHCARE PO BOX 1919 HOUSTON,TX77251 74-6074210	SUPP HTH SVCS	TX	501(C)(3)	LINE 7	CH		No
(17) CH WILKINSON PHYSICIAN NETWORK 1700 WEST LOOP SOUTH STE 400B HOUSTON,TX77027 76-0422435	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 11, TYPE I: 509	CH		No
(18) CHRISTUS CONNECTED CARE NETWORK 919 HIDDEN RIDGE DRIVE HOUSTON,TX75038 47-3403356	SUPP HTH SVCS	TX	501(C)(3)	LINE 11, TYPE I: 509	CH		No
(19) CHRISTUS CONTINUING CARE 1700 W LOOP SOUTH STE 1100A HOUSTON,TX77027 74-2898615	HEALTHCARE SERVICES	TX	501(C)(3)	LINE 3: 170(B)(1)(A)	CH		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) CHRISTUS MUGUERZA SAPI DE CV HIDALGO PTE 2525 64060 COL OBISPAD MONTERREY,N.L. MX 75-2562459	HEALTHCARE SVCS	MX	N/A	C				No
(2) EMERALD ASSURANCE CAYMEN LTD PO BOX 1051 KY1-1102 GRAND CAYMAN CJ 98-0407545	INSURANCE	CJ	N/A	C				No
(3) AMBULATORY STRATEGIES PHYSICIAN GROUP 919 HIDDEN RIDGE DRIVE IRVING,TX75038 47-2897732	HEALTHCARE SVCS	LA	N/A	C				No

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO CONTINUE THE HEALING MINISTRY OF JESUS CHRIST ACROSS THE CONTINUUM OF CARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	3
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	0
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	15
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	47,148,253	10,573,509
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-1,011,221	3,696,258
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	24,349	59,138
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	46,161,381	14,328,905
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	6,484	2,266
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	25,507,318	4,829,511
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	27,610,094	6,864,830
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	53,123,896	11,696,607
19	Revenue less expenses. Subtract line 18 from line 12.......	-6,962,515	2,632,298
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	25,440,443	21,269,814
21	Total liabilities (Part X, line 26).............	10,656,164	3,867,935
22	Net assets or fund balances. Subtract line 21 from line 20.....	14,784,279	17,401,879

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 9,146,889 including grants of $ 2,266 ) (Revenue $ 10,630,474 )
	TO FULFILL ITS MISSION, DUBUIS HEALTH SYSTEM, INC. PROVIDES LONG TERM ACUTE INPATIENT CARE TO INDIVIDUALS WHOSE CONDITION IS SO SIGNIFICANT THAT A HOSPITAL STAY OF ONE MONTH OR MORE IS ANTICIPATED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES AND SIGNIFICANT OTHER ARE PROVIDED FOR AS WELL.PATIENT CARE PROGRAM SERVICESTO THE LIMITS OF ITS RESOURCES, DUBUIS HEALTH SYSTEM, INC. IS AN INSTITUTION OF PUBLIC CHARITY; THUS, THE MOST TANGIBLE EXPRESSION OF DUBUIS' CHARITABLE PURPOSE IS THE PROVISION OF HEALTHCARE SERVICES TO THOSE PERSONS WHO ARE UNABLE TO PAY. THIS FALLS INTO TWO CATEGORIES: CHARITY CARE AND UNREIMBURSED MEDICAID.INPATINET CHARITY CARE - UNREIMBURSED COSTS OF PROVIDING CARE FOR THE FINANCIALLY AND MEDICALLY INDIGENTIN KEEPING WITH ITS MISSION, VALUES, AND VISION, DUBUIS HEALTH SYSTEM, INC. PROVIDES CHARITY CARE SERVICES IN A MANNER THAT RESPECTS THE DIGNITY OF THE PATIENTS AND THEIR FAMILIES. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHO ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHO'S MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY.UNRECOVERED COSTS OF PROGRAM BENEFITING THE POOR (UNREIMBURSED GOVERNMENT SPONSORED INDIGENT CARE) (MEDICAID)DUBUIS HEALTH SYSTEM, INC. IS AN ACTIVE PARTICIPANT IN THE STATE OF TEXAS MEDICAID PROGRAM. THAT PROGRAM SEEKS TO PROVIDE PAYMENT FOR HEALTH CARE SERVICES TO INDIVIDUALS WHO MEET CERTAIN FINANCIAL AND OTHER REQUIREMENTS. FINANCIAL REQUIREMENTS INCLUDE EVALUATION OF BOTH ASSETS AND INCOME.OTHER COMMUNITY BENEFITSREIMBURSED GOVERNMENT SPONSORED PROGRAMSIN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), DUBUIS HEALTH SYSTEM, INC. PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, TRICARE (FORMERLY CHAMPUS WHICH PROVIDES CIVILIAN HEALTH CARE BENEFITS TO MILITARY PERSONNEL, MILITARY RETIREES AND THEIR DEPENDENTS, AND SOME MEMBERS OF THE RESERVE COMPONENT) AND TRICARE FOR LIFE (A MEDICARE SUPPLEMENT IN INSURANCE PROGRAM AVAILABLE TO INDIVIDUALS WHO HAD BEEN ELIGIBLE FOR TRICARE).AS ALREADY CITED, DUBUIS HEALTH SYSTEM, INC. PROVIDED MEDICAL SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM WHICH, IN FACT, COMPRISED THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. NUMBER OF PATIENTS SERVED: 327NUMBER OF PATIENT DAYS OF CARE PROVIDED: 7,503NUMBER OF PATIENT DAYS OF CHARITY CARE PROVIDED: 20CHARITY CARE COST: $14,534CHARITY CARE CHARGES: $55,664OTHER COMMUNITY BENEFITS: $768UNREIMBURSED MEDICAID: $12,423

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses9,146,889

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,596,654	3,432,153	865,538

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......
			Business Code
2a	INPATIENT REVENUE NET OF VOLUNTAR		900099	10,573,509	10,573,509
b
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			10,573,509
3	Investment income (including dividends, interest, and other similar amounts).......
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		6,494,485
b	Less: cost or other basis and sales expenses		2,798,227
c	Gain or (loss)		3,696,258
d	Net gain or (loss)..........			3,696,258			3,696,258
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	FEDERAL GRANT		900099	47,778	47,778
b	MEDICARE INTEREST REVENUE		900099	7,808	7,808
c	VENDING MACHINE REVENUE & MEDICAL		900099	2,173			2,173
d	All other revenue ....			1,379	1,379
e	Total. Add lines 11a–11d ......			59,138
12	Total revenue. See Instructions......			14,328,905	10,630,474	0	3,698,431


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............				1
2	Savings and temporary cash investments .........			16,278,625	2	20,353,524
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			5,196,374	4
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............			1,763,000	7	456,929
8	Inventories for sale or use ..............			437,473	8
9	Prepaid expenses and deferred charges ..........			82,603	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	0
b	Less: accumulated depreciation .....	10b	0	0	10c	0
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,682,368	15	459,361
16	Total assets. Add lines 1 through 15 (must equal line 34)......			25,440,443	16	21,269,814
17	Accounts payable and accrued expenses .........			4,513,681	17	1,179,134
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			6,142,483	25	2,688,801
26	Total liabilities. Add lines 17 through 25.........			10,656,164	26	3,867,935
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			14,784,279	27	17,401,879
28	Temporarily restricted net assets ...........				28
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			14,784,279	33	17,401,879
34	Total liabilities and net assets/fund balances ........			25,440,443	34	21,269,814